Advocate calls out impact of ageism in response to elder abuse

A critical evaluation of ageism within policy and practice is needed in order for the sector to effectively tackle elder abuse, an advocacy group has said.

Aged Rights Advocacy Service residential projects manager Brenton Pope told Australian Ageing Agenda that often there was little consideration or acknowledgement as to how ageism or beliefs and opinions about older people impacted the recognition and response to elder abuse in residential aged care.

Mr Pope, speaking ahead of his presentation at the National Elder Abuse Conference in February, said while there was mandatory reporting of sexual and physical abuse within residential aged care, in some cases staff did not report as they did not recognise signs of abuse.

Looking at the example of physical abuse, he said staff could often assume a resident may have bruises from falling over and would not investigate how the bruises occurred. In cases of sexual abuse, staff may discount the reality of abuse occurring due to assumptions about older women’s attractiveness or a mistaken belief that sexual assault only happens to younger women.

Brenton Pope

Mr Pope said often beliefs such as these were subconscious, and people could only become aware of them and start to change their behaviour when they were specifically addressed and talked about openly.

“If we really want to address this effectively, I believe we need to have some process of critically examining those beliefs,” said Mr Pope.

Mr Pope said this needed to take place at organisational level, with an investigation of how certain beliefs may impact existing policies and procedures around elder abuse. There also needed be assessment of staff in order to develop targeted education and training, he said.

However, Mr Pope also made a distinction between ‘overt’ and ‘covert’ forms of elder abuse, and noted that while the sector generally recognised overt abuse was problematic and needed to be addressed, covert abuse was normalised and often deemed to be acceptable and appropriate.

Overt forms of abuse referred to situations that were commonly associated with elder abuse, such as physical, psychological, social, financial abuse and neglect.

Covert abuse, on the other hand, referred to policies and procedures that restricted residents’ human rights and ability to make decisions for themselves. This may refer to things such as not being able to leave the facility unaccompanied, a lack of ability to make choices around what they ate or activities they did, or the choice to have certain appliances or objects in their room. Mr Pope said often these restrictions had no rationale except that people were ‘old’.

Mr Pope acknowledged that in some cases, such as where a resident had dementia, a facility may need to take certain measures for safety. However, he said often restrictions were applied across all residents, such as in blanket bans on certain items, rather than based on individual assessment or merit.

“In the vast majority of cases we are dealing with, there’s no question of the facility being able to fulfil its duty of care while still respecting that person’s self-determination and their right to make autonomous decisions,” he said.

He argued in some facilities there was a disconnect between ideal of person-centred or consumer-directed care and practice. Mr Pope said restrictive policies and procedures were often dehumanising and had significant impact on residents’ quality of life.

In addition, Mr Pope noted that when staff, residents or family members questioned the legitimacy of these practices they were often labelled as ‘troublemakers’, or worse, bullied or intimidated. He argued management needed to consider policies and procedures from the perspective of people they served.

“It is time to pause and reflect, and completely look at a paradigm shift as to how these things are considered,” he said.

Mr Pope suggested that when putting a policy or procedure in place, facilities could apply a variety of questions in order to examine that policy from the perspective of potential ageism. Examples of such questions included:

• If this policy was applied to me personally, would I be comfortable with it?
• If I encountered these restrictions in my own home, would I be comfortable with complying to them?
• Would I be comfortable if the same policy was applied to younger people?
• If I were to apply this policy to a particular racial group or gender, only on the basis of their race or a gender, would it be considered to be socially appropriate and acceptable?

4 Responses to Advocate calls out impact of ageism in response to elder abuse

Thank you for raising awareness of the issues in residential care. Likewise, elder abuse appears to be generally unreported in community care. Sadly when it is, the response can be less than satisfactory.

This is an important article, thank you for bringing this to the forefront. Ageism influences policy, reflecting the attitudes of our broader community- a critical issue that needs to be addressed. I agree that much of ageism is subconscious and has a detrimental impact on the wellbeing and rights of older people, particularly people who are vulnerable or unable to speak up for themselves. Legislation, reforms and scarce resources puts pressure on organisations, staff and community services causing them to to react in terms of what is most efficient, and what is ‘right’.
Language is a major influence in this regard. For example, with duty of care, too often the best interest is in protecting the organisation and staff from risk, rather than considering best interest of the older person; the language shifting this view by stating (for example), “I have a duty of care to…” rather than “You have the right to…”. Language is a powerful indicator of ageism and with ageism comes a lack of respect and value for a person’s capacity, autonomy and worth. In this context, somehow it is forgotten that the older person being “protected” is an adult with more life experience than the person caring.
This is a problem across all of aged services and of our broader community; additionally language in policy can influence the value society puts on services. Policy language is influential to society in how we value the issues it aims to address. It is no secret that aged care is a growing area that the government struggles with resourcing. Yet with the subtle shift in language, older people may be kept within certain limits and the value of the person (true person-centred care) is secondary to service regulation and efficiency. To survive, the default position by organisations and workers, is to conform. A lack of resources to address the true needs and wellbeing/ respect of an older person in care is not an excuse for the defaulting ageist attitudes- unfortunately this is perpetuated by the lack of value that the government and society places on ageing, reflected in the wages and resourcing in this area.

I am so glad to see awareness is starting to happen with Elder Abuse. After spending many years as an Aged Care Nurse my total disappointment and frustration at how we treat our older people and see them as a burden on our society. We forget …they put us here…they are someone’s parent, aunt, uncle or friend. Sadly in regional areas we are seeing increased social isolation, sibling inheritance impatience with ageing population and an increase in elder abuse. Many instances are not reported or known of as the offenders can be the siblings or close family or friends. Sadly my father has been a victim of elder abuse. Although appointed a guardianship and advocacy which is 4 hrs away ….it continues. This has not protected my father from elder abuse. Many efforts to stop it occurring including Police notification have left me feeling totally disillusioned by our systems or lack of. The responses I have had have left me with the feeling that it “does not matter because he is old” ……or to hear that an incident that you report to Police from 3 weeks ago is history….terribly frustrating. No longer working in the industry I am now able to “voice up”. Becoming a volunteer Consumer Representative and getting involved with person centred care, health issues centre and council of the ageing has been my opportunity to begin the fight back against elder abuse for my father and many others. It’s time we opened the doors wide on what is happening in residential aged care facilities and in our communities. National laws need urgent reviewing and penalties implied. Community engagement and reconnection with our older community would be a good start. This all can start with the kids at school. No abuse is acceptable. “Age should never be a barrier to receiving good care….ever”.

There are so many aspects of abuse. It comes in many forms, some of which have not even been identified yet. For instance, one thing I have witnessed in staff who cannot speak English rearrange things like jumpers etc that families have specifically arranged so that their loved one can easily access. Lazy staff just push things in without any thought so then the person cannot find their jumper that they put somewhere. Then the staff member is called and gets angry because the system that the family set up to assist their loved one was not followed by staff. So the staff have caused the issue, then the staff get angry and abuse the client if they get confused. These issues cause a great deal of upset to both the resident and the family. So much more goes on than the family ever gets informed of.